女性初次经阴分娩后远期膀胱尿道及阴道三维解剖的变化  

Changes of 3D fine anatomy of bladder,urethral and vaginal after vaginal delivery

作　　者：陈兰[1] 陈春林[1] 刘萍[1] 陈瑞莹[2] 林洁[2] 陈金洋 唐连 王可竞 陈怡 Chen Lan;Chen Chunlin;Liu Ping(Department of Obstetrics and Gynecology,Nanfang Hospital of Southern Medical University,Guangzhou 510515)

机构地区：[1]南方医科大学南方医院妇产科山,广州510515 [2]南方医科大学南方医院影像科,广州510515

出　　处：《现代妇产科进展》2018年第8期571-574,共4页Progress in Obstetrics and Gynecology

基　　金：国家自然科学基金(No：81571422); 南方医科大学高水平建设临床研究重点项目(No：LC2016ZD019)

摘　　要：目的:探讨女性初次经阴分娩后远期膀胱尿道及阴道精细解剖结构的变化。方法:选取2013年1月至2016年10月于南方医科大学南方医院妇科就诊的已行MRI检查的53例患者,其中未孕未产者28例,经阴分娩1次者25例。收集患者的静息MRI影像数据,利用Mimics 10.01软件进行三维重建,联合UG软件对膀胱尿道与耻骨联合间的精细解剖参数进行三维测量和分析。结果:患者均可构建盆底器官三维模型,含骨盆、膀胱、尿道、子宫、阴道和直肠。膀胱尿道后角、β角、α角、耻骨后间隙,经阴分娩1次组比未孕未产组增大,但差异均无统计学意义;尿道耻骨角、尿道倾斜角、膀胱颈与耻骨联合下缘连线长度及尿道横纹肌厚度,经阴分娩1次组比未孕未产组减小,但差异均无统计学意义。近中远端尿道阴道间隙、近端和远端阴道前壁宽度,经阴分娩1次组较未孕未产增宽;阴道前壁中线长度,经阴分娩1次组比未孕未产组减小。中段阴道二维形态浅凹型占比,经阴分娩1次组比未孕未产组增加,但差异均无统计学意义。结论:患者经阴道分娩后膀胱尿道及阴道的空间解剖位置和形态发生了变化,表现为膀胱尿道位置向后向下移动,阴道前壁及尿道阴道间隙增宽。两组差异虽无统计学意义,但侧面反映了经阴道分娩后,膀胱尿道及阴道周围支持结构支持功能有所下降。Objective： Explore 3 D fine anatomy changes of bladder,urethra and vagina in women after vaginal delivery.Method： Analyze the MRI data and general clinical information of gynecological patients in Nanfang Hospital from Jan.2013 to Oct.2016.28 nulliparas and 25 women with only one vaginal delivery experience were selected,combine Mimics 10.01 and UG software to measure most kinds of anatomy parameters on 3 D models. Results： We built all 3 D models,including pelvis,uterus,bladder,urethra,vagina and rectum. The degree of bladder and urethra angle,β Angle,α Angle and retro-pubic space length of labor one group were bigger than that of nulliparas group.Urethra pubic Angle,urethra tilt Angle,the length between bladder neck and edge of pubic midpoint,and Urethral striated muscle thickness of labor one group were smaller than that of nulliparas group. The difference between two groups had no statistically meaning.Proximal-middle-distal urethral vaginal gap,proximal-distal vaginal anterior wall width of labor one group were wider than that of nulliparas group,while the length of vaginal anterior wall of labor one group was smaller than that of nulliparas group.The two-dimensional shape of axial vagina were H and shallow concave type,the proportion of shallow concave type of labor one group was higher than that of nulliparas group. The difference between two groups had no statistically meaning either.Conclusions： The spatial anatomical position and morphology of the bladder urethra and vagina are changed after vaginal delivery,like the bladder urethral move backward and downward,the anterior wall of the vagina is widened and the urethral vaginal space widened,with no statistically significant meaning,it helps reflect that after vaginal delivery,the support structure of bladder urethra and vaginal and its function have declined.

关 键 词：经阴分娩 未育 MRI 膀胱 尿道 阴道 三维 解剖 

分 类 号：R714.1[医药卫生—妇产科学]